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Twelve Children with Primary Renal Tubular Acidosis (RTA) Were Given Cortisone Acetate

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Twelve Children with Primary Renal Tubular Acidosis (RTA) Were Given Cortisone Acetate 382 ABSTRACTS NEPHROLOGY Recent studies have shown that the fetal kidney is limited in its ability to acidify the urine and to secrete hydrogen ions when The natural history of renal tubular acidosis: Lightwood's syn- compared to the adult kidney. To further study H+ secretion and drome revisited. MARTIN A. NASH, ANTONIO D. TORRADO, EDDIE the ability of the fetal kidney to establish a pH gradient between S. MOORE, JUAN RODRIGUEZ-SORIANO, IRA GREIFER, ADRIAN SPIT- blood and urine, Na2SO4 was infused into the intact fetus. Albert Einstein Coll. of ZER, and CHESTER M. EDELMANN, JR. Studies were done on 7 near-term pregnant sheep and their Med., N. Y., N. Y. fetal lambs. The ewes were injected with DOCA and the fetuses Twelve children with primary renal tubular acidosis (RTA) were given cortisone acetate. This served to enhance renal tubular studied with HCO3" titration and NH4C1 loading have been reabsorption of Na+. Caesarean sections were performed and 75cc observed 1V&-8 yrs. These include 1 $ with proximal RTA of 8% Na2SO4 was infused into each fetus. Blood and urine sam- (PRTA) dx'd at 7-18 mos, and 3 $ and 2 9 with distal RTA ples were collected from the ewe and fetus. There were no sig- dx'd at 3-13 yrs. Bone disease and/or nephrocalcinosis were pres- nificant changes in fetal or maternal blood pressure, pulse, tem- ent in DRTA but not PRTA. GFR (CIN) at onset was normal or perature or pCO . slightly decreased in PRTA, but 40-60% of normal in DRTA. 2 The mean initial urine and blood pH in the fetus was 7.075 GFR is now normal in all patients. With rx pts had accelerated and 7.352 respectively. The mean minimum urine pH in the fetus growth, reaching at least the 3rd percentile in 2-3 yrs, with after Na SO was 5.2 with a range of 4.7-5.7. The mean minimum some achieving the 50th percentile. Five with PRTA have nor- 2 4 blood pH in the fetus after Na SO was 7.362. The mean urine pH mal blood pH and HCO off rx, 5-8 yrs after dx. Two remain 2 4 3 in the ewe before and after Na SO was 5.824 and 5.920 re- on rx <2 yrs after dx. The acidification defect in pts with 2 4 spectively. This is consistent with little or no transfer of SO = DRTA persists. Thus PRTA appears to be a self-limited dis- 4 across the placenta. The mean maximum TA and NH, excretion ease of bicarbonate reabsorption in male infants, characterized in the fetus was 4.35 and 8.21 /iEq/min/kg respectively. There by growth retardation and acidemia, without bone disease and was no correlation between fetal weight and response time be- nephrocalcinosis. DRTA appears to be a permanent defect in fore production of an acid urine. urinary acidification, with acidemia, growth retardation, bone dis- These studies indicate that in the intact fetal lamb, a stimulus ease, and nephrocalcinosis. Response to rx in both groups is good, + with marked improvement in growth, and normalization of (DOCA) to the fetal kidney to reabsorb Na without equivalent GFR in DRTA despite severe degrees of initial nephrocalcinosis. amount of anion results in intense acidification of the urine. On the basis of these observations, it seems likely that Light- The fetal kidney is thus able to establish a pH gradient with no woods's syndrome was proximal RTA—not distal RTA as has evidence of intrinsic limitation of hydrogen ion secretion. been considered heretofore. Pressure gradients for filtration in the developing kidney. ADRIAN SPITZER (Intr. by Chester M. Edelmann, Jr.). Albert Einstein Maturation of intrarenal blood flow distribution in newborn Coll. of Med., N. Y., N. Y. puppies. LEONARD I. KLEINMAN and JOHN H. REUTER (Intr. by It is well documented, both in humans and animals, that low I. Light). Univ. of Cincinnati Coll. of Med., Cincinnati, Ohio. rates of glomerular filtration prevail during early postnatal life. Intrarenal glomerular blood flow distribution was studied in 34 Although several explanations for this phenomenon have been newborn puppies ranging in age from 1 to 40 days using radio- offered, no direct measurements of the forces responsible for labeled carbonated microspheres 15-25 fi. The technique was vali- glomerular filtration in the developing animal are available. dated by histological sectioning, dual labeling of microspheres This information was sought in the present study by micro- and multiple sectioning of the same kidney. Relative blood flow puncture techniques. Free flow proximal intratubular pressure per gram tissue to juxtamedullary inner cortical (IC) and outer (Pf), "stop flow" (Ps), mean arterial, and colloid-osmotic pres- cortical (OC) glomeruli was determined by the ratio of micro- sure of the plasma protein (Pc0), were determined in guinea pigs spheres trapped in the respective region. IC/OC ratios fell from ranging in age from 1 to 56 days (27 animals). The values obtained 1.2 at birth to 0.25 at 14 days and remained relatively constant were used in the calculation of glomerular capillary pressure, thereafter. There was no correlation between IC/OC ratio and Pcap = Ps + Pco. and of the effective filtration pressure, Pcff = PAH extraction (EPAH). EPAH remained constant at 0.50 during Pcap — (Pf + Pco)- Free flow intratubular pressure increased from the first 40 days of life (adult EPAH = 0.85). IC/OC ratio de- 5.5 ± 0.3 during the 1st to 9.2 ± 0.2 (mean ± S. E.) during the clined as blood pressure rose from 30 to 70 mm Hg and remained 8th week of life, whereas capillary pressure increased from 21.2 ± relatively constant at blood pressures above 70 mm Hg. These 1.8 to 29.3 ± 1.0 mm Hg. Since the actual increase in capillary results suggest that there is a marked change in intrarenal blood pressure was about twice the increase in intratubular pressure, flow distribution during the first two weeks of life as more blood effective filtration pressure rose accordingly from 4.9 ± 0.4 to 9.4 is delivered to outer cortical nephrons with maturation. The ± 0.8 mm Hg. During the same period mean arterial pressure early large flow to juxtamedullary glomeruli suggests a large post- changed from 42.9 ± 2.2 to 58.5 ± 7.9 mm Hg. It appears, there- glomerular medullary flow. The lack of correlation between fore, that an increase in glomerular capillary pressure is an im- IC/OC ratio and EPAH suggests that the low EPAH in the new- portant factor in the increase in glomerular filtration rate that born period is not due solely to a large medullary flow. Finally, is observed with age. intrarenal flow distribution maturation is closely related to blood pressure maturation. Ontogeny of amino acid transport sites in kidney: specific and total activity. K. BAERLOCHER, C. CLOW, S. MACKENZIE and C. The effect of Na2SO4 on urinary acidification in the intact fetal SCRIVER. McGill Univ.-Montreal Children's Hosp. Res. Inst., lamb. EDDIE S. MOORE, CLARENCE W. DELANNOY, and JOHN B. Montreal, Que., Can. PATON (Intr. by Richard Behrman). Univ. of III. Coll. of Med. Urinary hyperexcretion of proline, hydroxyproline and glycine Chicago, III. is a defined component of the transient impairment in tubular ABSTRACTS 383 absorption of amino acids after birth in man and rat. In both liminary studies suggest that calculation of selectivity is possible species, loss of iminoaciduria precedes reduction of hyper- even at low levels of protein excretion by comparison of clearance glycinuria. This coincides with in vitro evidence in rat for phased of transferrin, IgG and tt2 macroglobulin performed on urine, in "activation" of substrate-specific membrane carriers, the one which the protein has been concentrated by lyophylization. for proline appearing early, that for glycine, late. "Activation" apparently involves appearance of new carrier proteins rather Plasma norepinephrine concentration before and after albumin than gain in energy coupling to existing carriers, since studies of infusion in nephrotic children. ROBERT C. KELSCH, GERALD S. amino acid interaction during influx, heteroexchange and inhibi- LIGHT, and WILLIAM J. OLIVER. Univ. of Mich. Med. Ctr., Ann tion of energy metabolism indicate a specific initial lack of rele- Arbor, Mich. vant carriers. However "maturation" of total amino acid trans- A reduction of effective plasma volume secondary to a decrease port in kidney also involves another component. By comparing in the quantity of circulating protein is postulated to initiate Vmax for uptake in vitro of proline, glycine and a-amino iso- edema formation in the nephrotic syndrome, however reduction butyric acid on carriers present from birth, we found their rela- of plasma volume has not been consistently demonstrated during tive capacities to increase synchronously after birth. This is com- active disease. Acute and chronic reduction of plasma volume is patible either with increasing membrane area or with more effi- associated with an increased excretion of norepinephrine, pre- cient coupling of energy to transport. Thus changes both in sumably secondary to increased sympathetic activity. We therefore specific activity of carriers and in total membrane activity charac- studied certain aspects of norepinephrine metabolism in thirteen terize ontogeny of amino acid transport in kidney. children with the active nephrotic syndrome. All children were on a lV^-2 mEq/kg/day sodium intake and no diuretic therapy. Clinical-pathological correlations in the nephrotic syndrome. A Plasma norepinephrine concentration was measured on two con- report of the international study of kidney disease in children. secutive mornings and again four hours later each day. Albumin CHESTER M. EDELMANN, JR., A. Einstein Coll. Med., N. Y. (6-18 grams) was infused 3 hours prior to the second blood 191 children with idiopathic nephrotic syndrome (absence of sample on the second day.
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